AUDITS: Keep An Eye On The Charts Requested by 'Bounty Hunters'

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains an audit-related Medicare issue involving Recovery Audit Contractors (RACs) and their requests for medical records from providers. It focuses on the expansion of RAC review activity, concerns about claims that had already been appealed, and the role of CMS in addressing communication problems between contractors and carriers. The piece is relevant to physicians, billing staff, compliance teams, and anyone monitoring Medicare audit activity and documentation requests.

Why This Topic Matters

Providers need to recognize when audit requests may involve claims that have already been through the appeal process, because such requests can create unnecessary administrative burden and potential compliance confusion. The article highlights why awareness of RAC activity and timely communication with CMS matters for managing Medicare documentation requests.

What You Will Learn

  • How RAC activity is affecting Medicare claims review
  • Why repeated requests for documentation can raise concerns
  • How CMS is involved when audit-related communication problems arise
  • Who should pay attention to changes in audit activity and record requests

Who Should Read This

  • Physicians
  • Medical billing professionals
  • Hospital and physician practice compliance teams
  • Revenue cycle staff
  • Medicare providers

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